Chiropractors remain underutilized by province’s health care system

The CEO of the Provincial Chiropractic Association responded today to media attention surrounding the need for physicians to choose more wisely when it comes to the type of care a patient receives. Dr. Darrell Wade DC suggested that not enough is being done to make real changes to the way that health services are delivered in NL. “The health care model that we currently use has so much room for improvement, and there are proven ways to improve health care but it can’t happen unless we are ready to let go of perceptions that keep us doing what we have always done.” Wade was speaking in reference to programs like the Inter-professional Spine Assessment and Education Clinics (ISAEC) in Ontario which use Chiropractors and Advance Practice Physiotherapists to assess patients before they are referred to specialists such as orthopaedic surgeons. “ What they found” said Wade “ was that when patients were seen by one of these expertly trained professionals first, over 90% of cases were diverted from specialists and surgeons’ offices and the use of tests such as MRI’s was reduced by over 30%. That is what is required here yet there is resistance to move towards this type of model. We need to really ask what is holding us back and be prepared to answer honestly if anything is going to change for the better”

The ISAEC program which started in 2012 is funded by the government of Ontario and Wade suggested that the NL government should be looking at similar models if there is a real desire to make meaningful change. Wade went on to say “This is just one program that could have a drastic impact on reducing wait times and health care costs and improving outcomes. There are many more like this one that are used successfully in other parts of the country yet in NL we continue to do what we have always done. The problem with this is that you can’t do what you have always done and expect a different outcome….it just doesn’t work like that. Chiropractors are experts in assessing and treating back pain but the system is stuck in a model that places real barriers to the best provider of care being accessible to patients. Unfortunately until this changes we will continue to reap what we sow.”

More information on the Inter-professional Spine Assessment and education Clinics can be found at


About the Newfoundland and Labrador Chiropractic Association
The Newfoundland and Labrador Chiropractic Association (NLCA) is the organization responsible for representing Newfoundland and Labrador’s 68 licensed doctors of chiropractic. The NLCA advocates on behalf of members and their patients to advance the quality and accessibility of chiropractic care in Newfoundland and Labrador, and to improve the effectiveness and efficiency of the healthcare system. For more information on the NLCA or for a referral to a doctor of chiropractic, please visit

For further information, contact the NLCA office at or (709) 739-7762

Message to Injured Workers requiring ongoing Chiropractic Care

Despite a public commitment by WHSCC to continue to pay for necessary chiropractic services for injured workers, chiropractors who are working outside of a contract have been unable to secure written approvals for most patients that require ongoing treatment in relation to a work related injury.

Chiropractors have committed to ensuring that injured workers have access to necessary care however in the absence of written approval prior to treatment, injured workers will be required to assume the cost of care and seek reimbursement from WHSCC.

We are aware that your case manager may have called to inform you that your chiropractor is not able to collect payment for care that is provided to you however it is clear that injured workers are being misinformed in a number of cases. Therefore it is necessary that our patients are clearly informed that chiropractors are only able to bill directly to WHSCC when they have been informed in writing that they are entitled to payment by the commission in relation to your work related injury. In the absence of this approval in writing, the term “injured worker” is not applicable with respect to treatment and therefore there is no restriction on the ability of a patient to pay for services that they receive.

While the province’s chiropractors would prefer to invoice directly to WHSCC for the care that you receive, as a result of the unwillingness of WHSCC to provide written approval to your chiropractor for your individual care, your chiropractor is unable to invoice WHSCC for this care.

If you have concerns with your eligibility for payment by WHSCC, please contact your case manager and ensure that your chiropractor receives approval to invoice WHSCC for care. If your case manager is willing to provide written approval for your care in advance of your appointment, your chiropractor will invoice WHSCC for your care for as long as this approval remains in effect.

In the absence of approval by WHSCC, it is your right to continue to receive necessary health care services that you require and your chiropractor will continue to provide this care to you at their established office rates for non-WHSCC patients.

Real life cases from chiropractors/injured workers on effects of administrative barriers on health of injured workers.

Please Note: Although the following cases are based on real occurrences, information that may identify individuals associated with these cases have been changed in order to protect confidentiality.

May 19, 2016: Case 4: 35-year-old female with repetitive strain injury associated with data entry, computer and keyboard work. Taken off work due to pain and functional disability. She was treated by her doctor and a therapist for over 12 months and continued to struggle with work related tasks and could not stay at work. One year after initial treatment began, she was finally referred to a chiropractor. After only four weeks of treatment by her chiropractor she was symptom-free and back to her regular activities and is not currently missing any work.

Research consistently shows that when an evidence based approach is applied to the treatment of patients, the outcomes are better and cost is significantly reduced. ( In this case, evidence based care would have put this patient in a chiropractor’s office directly after their injury or at least after a short course (3-4 weeks) of other therapies that may have been effective for this injury had not been successful. Instead, this patient and their employer were negatively affected for over a year due to the mismanagement of the claim and the refusal of WHSCC to embrace research based approaches that ensure that injured workers receive the best possible care in a timely manner.

Should WHSCC be held accountable to manage claims in the most effective and cost effective manner in order to save employers money and reduce lost productivity? Can health providers work effectively in a system where the necessity and character of care is determined by a business model rather than an evidence based health care model? How many Injured workers suffer at the hands of this outdated model of care every year?  What is the annual cost to employers of this mismanagement?

May 18, 2016: Case 3: Injured worker presented to their chiropractor on May 18, 2016 for care related to an ongoing issue as the result of a work related injury. In the absence of written approval, the chiropractor has been instructed by WHSCC case manager that they must complete a lengthy form outlining the need for care despite the fact that this had been previously well established for this patient. The chiropractor was informed that they would not be reimbursed by WHSCC  for the completion of this form and that they could not recover the cost associated with completing this form from the injured worker.  Care could not be guaranteed to be approved until the case manager reviewed the information on the requested form causing further delays in care. In the absence of a commitment from WHSCC to reimburse the chiropractor for the reasonable cost of completing this form, as is done for other health care providers, and to guarantee approval of care in a timely manner,  the chiropractor was unable to take time away from patient care in a busy clinic to complete this form. The injured worker is now told by WHSCC that she cannot access care because there is no approval.

What happens to this injured worker now that they cannot access their necessary care? Should the chiropractor treat if the patient is willing and able to cover costs associated with treatment? What are the ethical considerations when a chiropractor determines that care is necessary but WHSCC tells the chiropractor that, in the absence of approval,  they cannot treat?

May 17, 2016 Case 2:  In March 2016 patient presented to their chiropractor with RE-Occurance of a previous injury. Pt had chose their chiropractor as their primary health care provider for this case as the chiropractor had successfully resolved similar issues for them in the past.  As the Primary Provider, the chiropractor should be the health care provider that primarily directs necessary care in relation to the injury.

As with all RE-Occurance of Injury it usually takes a week or 2 to render a decision from WHSCC. Under these circumstances, especially because the patient required immediate attention to reduce pain and remain at work, the pt had agreed that should WHSCC decide the case is not legitmate, the pt will cover the costs. Otherwise the patient would have had to stop work due to pain while awaiting approval.  The pt had extensive treatment over 2 months which helped them remain at work. As the patient’s cost associated with care was continuing to rise, and still no correspondence from WHSCC with approval, the patient decided to end care at that time despite the fact that the condition was not fully resolved. Several weeks later the patient’s symptoms intensified once again and because there was still no decision from WHSCC (2 MONTHS LATER), The patient consulted their MD who referred the patient for a different form of treatment by another health professional . This care was approved 1 week later!!! and yet her initial claim that should have initiated the claim process, completed by the chiropractor, was still not approved.

 2 weeks later the patient reappeared in the chiropractors office as the treatment recommended by their MD was not as effective as the care that had been administered by the patients chiropractor. After the patient explained the current situation to the chiropractor, a call was made to WHSCC and the chiropractor was informed that there was an over site on this claim and no one had looked at it until now. The chiropractor was informed that the claim would be approved only on a go forward basis, leaving this pt to pay the bill for care received up to this point. The chiropractor rebutted this statement by saying ” you just admitted WHSCC made a mistake and it is a legitimate claim, so why should this patient have to pay. The case manager advised that they would consult their superiors on this matter.

The next day the chiropractor received notification that the past treatment would still not be covered leaving the patient to pay for the costs associated with an injury that was confirmed to be in relation to a work related cause. The patient decided to appeal the decision by WHSCC to not pay for this care. After considerable effort this patient was informed that the cost of the previous care would be covered.

Was this case managed in a manner that promoted the best possible care of the injured worker? Were there unnecessary barriers that may have impacted this patient’s well being both physically and mentality? In a system that is supposed to be there to protect injured workers how can this continue to happen?



May 16, 2016- Case 1: 25 yr old patient awaiting approval of care since report sent by chiropractor 9 weeks ago. Patient has been under care previously and managed well when receiving treatment. Continuation of chiropractic treatment for management of pain and disability has also been recommended by medical specialist. Chiropractor informed that WHSCC will require another form to be completed and patient will have to wait for this to be reviewed for approval as initial form submission is now outdated. Should the chiropractor treat as they know is required or allow administrative delays at WHSCC to impact the health of this injured worker? Who is responsible to pay for care received? Is this patient still considered an injured worker in the absence of approved payment by WHSCC? Too many unanswered questions. Patient still waits for approval and suffers.

Chiropractors continue to provide care to some injured workers: Administrative barriers still affecting care of others

As of May 18th, 2016 Chiropractors will continue to bill directly to WHSCC for care that has been previously authorized however chiropractors will no longer complete 8/10 reports as these reports impose significant time burdens on chiropractors and are being imposed on chiropractors in an inequitable manner. As a result, patients who have been previously authorized for care as an injured worker whose approval has expired will be required to pay for care upfront in the absence of a written approval from WHSCC that your care is eligible and approved for billing directly to WHSCC. This will also apply to those patients presenting for treatment of an initial injury as information on the nature of this injury will no longer be relayed to WHSCC via 8/10 forms due to the unwillingness of WHSCC to reimburse chiropractors for the information that they provide on these forms in an equitable manner.

If you feel that your injuries are the result of a workplace injury please contact your case manager to ensure that your chiropractor has received approval to invoice WHSCC directly before your visit. Treatment that is not approved in writing in advance of your visit will require payment at the time of examination or treatment.

Notice to patients currently being covered by WorkPlaceNL for Chiropractic Services

Effective April 23rd, 2016, the Memorandum of Agreement (MOA) between the majority of the province’s chiropractors and the Workplace Health, Safety and Compensation Commission (WHSCC) has ended. In the absence of a written MOA, chiropractors had agreed to continue with the provision of necessary care to injured workers outside of a contract on the commitment that WHSCC would continue to honour their legislative duty to pay for these services outside of a contract and work towards arriving at a mutual resolution. While your chiropractor has honoured their commitment to provide these necessary services, WHSCC has not honoured the commitment made publically by WHSCC CEO Leslie Galway to continue discussions with the Newfoundland and Labrador Chiropractic Association (NLCA) in order to ensure that care of injured workers is not compromised. As a result of this refusal to honour their stated commitment, effective May 18th, 2016, chiropractors will no longer bill directly to WHSCC without express written confirmation, on a case by case basis, that the cost associated with this care will be covered by WHSCC. Chiropractors will no longer provide information to WorkplaceNL on 8/10 forms and therefore an injured worker who wishes to have care approved for payment by WHSCC will need to contact their case manager in order to have confirmation of approval issued to the treating chiropractor . While the province’s chiropractors have made every attempt to avoid this undesirable outcome, 2 main issue that remain unaddressed by WorkplaceNL make this action necessary.

1. The NLCA has, on several occasions since April 23rd, requested that the commission provide written confirmation of the process that our members are expected to use in order to determine if a patient is eligible for funded care by WHSCC. As eligibility for payment by WHSCC is not determined by your chiropractor and your chiropractor has not received information requested of WHSCC on how eligibility will be determined, there is significant risk that the costs associated with care will not be covered due to administrative barriers and this will leave patients with significant financial burdens should a significant course of care be established but not covered by WHSCC. It is therefore essential that all patients are aware before beginning a course of necessary care that the financial responsibility for care received is their individual responsibility when not expressly approved by WHSCC

2. WHSCC has clearly communicated in recent weeks that there has been no change in its position on the outstanding issues that resulted in the termination of the contract for chiropractic services on April 23rd, 2016. This communication is contradictory to the message that was publically communicated by Ms. Leslie Galway, CEO of WHSCC in media interviews and as a result it is clear that WHSCC continues to operate in a manner that is not reflective of reasonable etiquette during professional negotiations. In light of this lack of commitment to honour statements made in public outlets to continue discussions, our members must now also assume that commission has no intention to honour its public commitment to pay chiropractors directly for the costs associated with care to injured workers outside of a contract. As a result the provinces chiropractors are left with little option but to insist that payment be provided at the time of service in the absence of written confirmation that the cost of care will be covered.

WHSCC has been informed of this action that has resulted from their neglect to honour public commitments that would ensure that services provided by your chiropractor will be paid by WHSCC and this action will remain in effect until a mutually negotiated contract that is approved by the NLCA and the province’s chiropractors is officially executed.

Any changes or updates to this position will be broadcast on twitter through @nl_chiropractic and posted at

Please be assured that the chiropractors of Newfoundland and Labrador remain committed to the provision of essential and necessary care to each and every Newfoundlander and Labradorian and that this current action by the province’s chiropractors is intended to ensure that patients continue to receive timely access to necessary care in the absence of a written agreement by WHSCC to cover the costs associated with this care.

If you have questions or concerns related to your eligibility for benefits relating to your work related injury, please contact your case manager or WorkplaceNL at 778-1000